Healthcare Provider Details

I. General information

NPI: 1215166566
Provider Name (Legal Business Name): KAREN MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CABOT RD SUITE 209
MEDFORD MA
02155-5177
US

IV. Provider business mailing address

1400 WORCESTER RD APT 7108
FRAMINGHAM MA
01702
US

V. Phone/Fax

Practice location:
  • Phone: 161-727-5358
  • Fax:
Mailing address:
  • Phone: 161-727-5358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: